In 1871, Woodworth was appointed the first Supervising Surgeon of the
Marine Hospital Service. The Service had its origins in a 1798
Act of Congress "for the relief of sick and disabled seamen." The 1798 law created a fund to be used by the
Federal Government of the United States to provide medical services to
merchant seamen in American ports, which was expanded to include military and others who made their living associated with seagoing. The marine hospital fund was administered by the
Treasury Department and financed through a monthly deduction from the wages of the seamen. Medical care was provided through contracts with existing hospitals and, increasingly as time went on, through the construction of new hospitals for this purpose. The earliest marine hospitals were located along the
East Coast of the United States, with
Boston being the site of the first such facility, but later they were also established along inland waterways, the
Great Lakes, and the
Gulf Coast and
Pacific Coast. The marine hospitals hardly constituted a system in the
Antebellum period. Funds for the hospitals were inadequate, political rather than medical reasons often influenced the choice of sites for hospitals and the selection of physicians, and the Treasury Department had little supervisory authority over the hospitals. During the Civil War, the
Union and
Confederate forces occupied the hospitals for their own use, and in 1864 only 8 of the 27 hospitals listed before the war were operational. In 1869, the
United States Secretary of the Treasury commissioned an extensive study of the marine hospitals, and the resulting critical report led to the passage of reform legislation in the following year. The 1870 reorganization converted the loose network of locally controlled hospitals into a centrally controlled
Marine Hospital Service, with its headquarters in
Washington, D.C. The position of Supervising Surgeon (later
Surgeon General) was created to administer the Service. Woodworth began his service in the position on March 29, 1871, and he moved quickly to reform the system. He adopted a military model for his medical staff, instituting examinations for applicants instead of appointing physicians on the recommendation of the local Collector of Customs. Physicians, whom Woodworth placed in uniforms, were no longer appointed to serve in a particular facility, but appointed to the general Service. In this way, Woodworth created a cadre of mobile, career service physicians who could be assigned and moved as needed to the various marine hospitals. The uniformed services component of the Marine Hospital Service was formalized as the
Commissioned Corps by legislation enacted in 1889 under Woodworth's successor,
John B. Hamilton. In 1872, Woodworth initiated the publication of annual reports of the Marine Hospital Service. That same year he also served as one of the founders of the
American Public Health Association. From the time of his appointment, Woodworth envisioned broader responsibilities for the Marine Hospital Service, well beyond the care of merchant seamen. In 1873, his title was changed to Supervising Surgeon General. He issued publications on
cholera and
yellow fever, and laid the foundations for the passage of the
National Quarantine Act of 1878. This Act conferred
quarantine authority on the Marine Hospital Service, initiating a process whereby over the next half a century the Service progressively took over quarantine functions from the states. The Act also authorized the publication of
Bulletins of the Public Health (the forerunner of the Service's journal
Public Health Reports). The Marine Hospital Service thus moved into public health activities under Woodworth, paving the way for its later evolution into the
Public Health Service. Woodworth also designed the seal of the Service, which he first used on a publication that he authored in 1874 on Nomenclature of Diseases. The seal consisted of a fouled anchor, to represent the seamen cared for by the Service, and the
caduceus of Mercury. The latter symbol was particularly appropriate since it served as a symbol of commerce (which could represent the merchant marine) but was also used by the
Army Medical Corps as its symbol. With minor changes in design, this device has remained the seal of the Public Health Service to the present day. Woodworth remained in the position of Supervising Surgeon General until his death in Washington, DC, on March 14, 1879. ==References==